Atypical alcohol intoxication: definition, variants and clinical manifestations. Atypical alcohol intoxication Atypical alcohol intoxication
Factors predisposing to the development of atypical forms of simple alcohol intoxication are different. These may be residual organic lesions of the brain, early age the beginning of alcohol consumption, combined intake of various types of alcoholic beverages, simultaneous intake of alcohol and drugs, somatic disease accompanied by asthenia, lack of sleep, malnutrition, overwork, psychogenia. In this case, there is an excessive strengthening or weakening of the disorders that accompany intoxication, or a change in their dynamics, as well as the appearance of symptoms that are not characteristic of intoxication. The mental signs of simple intoxication undergo the greatest changes.
Dysphoric form of alcohol intoxication.
Instead of euphoria, malice, irritability, anger, a gloomy mood appear, leading to conflict and. An intoxicated person experiences a feeling of discomfort, hyperesthesia appears. Anger spreads to everything around, accompanied by captiousness, causticity, the search for a reason for quarrels. This state may persist for several days. This form of intoxication usually develops with an organic pathology of the brain.
Paranoid form of alcohol intoxication.
It is characterized by the appearance of suspicion, resentment, captiousness. Intoxicated people inadequately evaluate the words and actions of others as a desire to humiliate, deceive, ridicule. The motor and speech excitement intensifies, the drunks shout out separate phrases or words, testifying to the danger threatening them. This form of intoxication is often accompanied by aggression towards others, independent of their words and actions. The paranoid form of intoxication develops in primitive personalities, paranoid and epileptoid psychopaths.
Hysterical form of simple alcohol intoxication .
The behavior of the intoxicated is designed for the audience. The movements are theatrical (stormy scenes of despair, throwing, wringing hands) sometimes with an element of puerilism. Statements are pathetic with various accusations against others, self-praise or exaggerated self-reproach. Demonstrations are often made. This form of intoxication usually develops in persons with hysterical character traits.
Depressive form of simple alcohol intoxication.
Instead of euphoria, a depressed mood prevails. There are tearfulness, unpleasant memories, self-pity, feeling, longing, ideas of self-blame and suicidal thoughts. The risk of suicide attempts in this case is high.
Manic form of simple alcohol intoxication.
An elevated mood prevails with carelessness, complacency, accompanied by inappropriate jokes, various "naughty" actions. The behavior of some intoxicated is manifested by foolishness, stereotypy, antics, echolalia. Such forms are typical for adolescents and young men.
Epileptoid form of simple alcohol intoxication.
It is characterized by motor excitation with irritability, aggravated by opposition from others. Intoxicated people are initially aggressive towards those who reprimand them or try to calm them down, and then the aggression spreads to everyone who happened to be nearby. However, even at the height of the episode, there is no complete separation from reality. are reduced critically with subsequent sleep. Quite often the period of excitation is amnesiac.
A somnolent form of simple alcoholic intoxication.
After a short euphoria, shortly after drinking alcohol, a deep sleep sets in, sometimes turning into a stupor or coma.
An explosive form of simple alcohol intoxication.
The state of euphoria under the influence of minor external factors is replaced by sharp discontent, irritability, anger. These outbreaks are usually short-lived, alternating with periods of rest, but repeatedly repeated against the background of intoxication.
Simple alcohol intoxication, including its atypical forms, retains the main signs of acute alcohol intoxication, while productive (psychotic) forms of consciousness disorder do not occur. A variety of actions and statements of a drunk have a selective focus. The presence of persons capable of resisting with unpleasant consequences for a drunk influences his behavior. Intoxicated people always retain the possibility of contact with others.
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Alcohol intoxication
Table of contents
- Introduction
- 3. Pathological intoxication
- Conclusion
- Bibliographic list
Introduction
Alcohol is the most commonly used psychoactive substance. Alcohol-containing drinks from the standpoint of pharmacology, toxicology and narcology - narcotic substance. But since alcohol is not listed as controlled as a drug, alcoholism is not legally considered a drug addiction. In the system of organizing drug treatment for the population, alcoholism occupies a leading place and represents the main form of diseases in this group.
Ethyl alcohol acts mainly on the central nervous system. It causes a characteristic alcoholic excitation. First of all, under the influence of alcohol, the activity of the cortex is disrupted. hemispheres the brain, and with an increase in its concentration in the blood, cells of the spinal cord and medulla oblongata are affected. Spinal reflexes suffer only with deep intoxication. Under the influence of alcohol, the reactivity and efficiency of cortical cells decrease, which leads to the disruption of complex conditioned connections. Excitation characteristic of alcoholic intoxication does not in any way indicate the true stimulating effect of alcohol. It causes inhibition of the inhibitory processes of the cerebral cortex, leading to the release of subcortical centers, which determines the picture of alcoholic excitation. In large doses, alcohol also depresses the subcortical centers, which can lead to a coma. Under the influence of alcohol, the coordination of the antagonist muscles is disturbed, which leads to inaccurate movements: the gait of the intoxicated becomes shaky, uncertain (to a large extent this is also due to the dysfunction of the vestibular apparatus).
Alcohol, acting mainly through the central nervous system, is a strong stimulant of the secretion of the gastric glands, but the gastric juice secreted at the same time is poor in enzymes, and its digestive capacity is reduced. The local effect of alcohol on the gastrointestinal tract is also significant, the prolonged hyperemia and stagnation in the blood vessels caused by it lead to degenerative changes in the parenchymal elements of the mucous membrane, which becomes smooth and eroded.
Alcohol enhances the motor function of the stomach, and therefore the evacuation of its contents occurs faster. When taken orally, under normal conditions, about 20% of the alcohol taken is absorbed in the stomach, and the remaining 80% in the small intestine. Alcohol diffuses into the wall of the stomach and small intestine, most of it enters unchanged directly into the bloodstream. Another part of the alcohol penetrates the wall of the stomach and small intestine and enters the abdominal cavity, from there it is absorbed by the large surface of the peritoneum and only then enters the bloodstream.
The purpose of this work is to consider the activities of law enforcement officers in case of atypical and acute reactions when drinking alcohol.
1. Simple alcohol intoxication
Simple alcohol intoxication can manifest itself in mild, moderate and severe degrees.
A mild degree of simple alcohol intoxication (usually with a blood alcohol concentration of 1-1.5%) is manifested by a feeling of warmth, flushing of the skin, increased heart rate, increased appetite, and sexual desire. Attention is easily distracted, the pace of thinking accelerates, inconsistency and superficiality begin to predominate in it. In movements, there is a large scope, impetuousness, and a decrease in accuracy. The mood improves, there is a feeling of cheerfulness and contentment, pleasant thoughts and associations prevail, the perception of what is heard and seen has a predominantly positive color. Fluctuations in the emotional background, if they occur, are shallow (slight resentment, annoyance, impatience with a touch of irritation) and soon pass. Speech becomes louder and faster, but there are either no articulation disorders, or, more rarely, they are slightly expressed. The critical attitude both to one's condition and to the duties performed decreases. After some time from the onset of intoxication, elated mood is gradually replaced by lethargy and indifference, physical activity gives way to relaxation; thinking becomes slower. The state of fatigue is growing, there is a desire to sleep. After mild degree intoxication, lasting an average of several hours, no unpleasant mental and physical sensations are noted, memories of the period of intoxication are preserved.
Average degree simple alcohol intoxication (blood alcohol concentration from 1.5 to 3%) is characterized by more gross changes in behavior. Speech becomes dysarthric and louder due to an increase in the threshold of auditory perception. Representations are formed with difficulty, their content is monotonous. The slowdown of the associative process makes it impossible to choose a synonym or replace a difficult word. There are frequent repetitions of the same phrases. Attention switches slowly, only under the influence of strong stimuli. The ability to critically assess one's capabilities and the actions of others is sharply reduced. This leads to the emergence of various kinds of conflicts, which are due to the overestimation of the intoxicated own personality and the disinhibition of drives and desires. The surrounding situation is assessed only fragmentarily, as a result of which inadequate, including illegal, actions are often committed. Movements become uncertain, motor skills are even more upset and symptoms of ataxia appear. Practically all persons with moderate intoxication have gross violations of handwriting, staggering with a tendency to fall in the Romberg position, and weakness in the reaction of pupils to light. It should be emphasized that a person who is in a state of moderate intoxication, despite the symptoms described above, is capable of very correct and accurate remarks not only to those around him, but also to himself, i.e. mental disorders are always dissociated.
Moderate intoxication is usually replaced by deep sleep. Upon awakening, the consequences of intoxication are felt: weakness, lethargy, weakness, dry mouth, thirst, a feeling of heaviness in the head, in some cases irritability or depressed mood. Physical and mental performance is reduced. About the events that took place during the period of intoxication, especially those that were not emotionally significant, memories are vague, with individual episodes being remembered.
A severe degree of simple alcohol intoxication (the concentration of alcohol in the blood is from 3 to 5% and above) is determined by the appearance of symptoms of stupor of consciousness of various depths. In the most severe cases, an alcoholic coma develops. Neurological disorders are always observed: cerebellar ataxia, muscle atony, amimia, severe dysarthria. Vegetative disturbances intensify: respiration is reduced up to its pathological forms, the tone of the cardiovascular system decreases, cyanosis of the extremities and hypothermia appear. Vestibular disorders are often observed: dizziness, nausea, vomiting. In some cases, epileptiform seizures occur. Possible involuntary discharge of urine and feces. After severe intoxication has passed, adynamic asthenia is observed for several days, initially accompanied by ataxia, dysarthria, and various autonomic disorders. Anorexia and sleep disturbances are characteristic. Severe intoxication is usually accompanied by complete amnesia - the so-called. narcotic amnesia.
2. Atypical forms of simple alcohol intoxication
These are states of mild or moderate acute alcohol intoxication, in which (compared to simple intoxication) an excessively sharp increase or, conversely, weakening of some disorders occurs, or the sequence of their occurrence is disturbed, or symptoms develop that are not characteristic of simple alcohol intoxication.
Mental disorders undergo the greatest modification; much less - neurological. Altered forms of simple alcohol intoxication usually occur under various concomitant conditions: on pathological grounds (psychopathy, oligophrenia, mental illnesses of various genesis, with residual organic brain damage, early onset of alcoholism, developed alcoholism, simultaneous use of alcohol and drugs, combined intake of various types of alcoholic beverages, in cases where intoxication is preceded by a somatic disease or it occurs against its background, as well as in case of lack of sleep, overwork or psychogenic disorders.The selected options reflect the prevailing psychopathological disorders.
Explosive variant of a modified simple alcohol intoxication. The state of euphoria is expressed weakly and easily spontaneously or under the influence of external insignificant circumstances by transient outbursts of sharp discontent, irritation or anger. Accordingly, the content of statements and behavior change. Usually these outbreaks are short-lived, alternating with relative calm and even complacency, but during intoxication they are repeated repeatedly.
Dysphoric variant of altered simple alcohol intoxication. A persistent state of tension prevails, accompanied by discontent, gloom, hostility or anger. In almost all cases, a low-dreary affect can be detected. Hostility and anger spread to everything seen and heard: the intoxicated becomes picky, caustic, cocky, looking for a reason to quarrel. A feeling of somatic discomfort and hyperesthesia are often detected. The above violations can be observed for several days after the alcoholic excess.
A hysterical version of a modified simple alcohol intoxication. The behavior of an intoxicated person is always designed for the viewer. There is a simulated affect with a tendency to loud phrases, recitations, the content of which usually comes down to unfairly received insults. Often in statements that differ in pathos, various accusations against others, self-praise or, on the contrary, exaggerated self-reproach, predominate, fantasizing is often observed.
A depressive version of a modified simple alcohol intoxication. The clinical picture is dominated by a depressed mood of varying severity and shades. As a rule, the euphoria of the initial period is either absent or short-lived. In relatively mild cases, there is a subdepressive affect with tearfulness, unpleasant memories, self-pity. In more severe cases - longing, a feeling of hopelessness, anxiety, which are accompanied by self-reproach and suicidal thoughts. Due to the lack of motor inhibition in this state, the likelihood of suicidal attempts is high.
Modified simple alcohol intoxication with impulsive actions, as a rule, is observed in patients with schizophrenia and is usually accompanied by sexual perversions - homosexual acts, exhibitionism, flagellation. Pyromania and kleptomania are much less common.
Altered simple alcoholic intoxication with a predominance of somnolence. After a short and mild period of euphoria, a state of drowsiness occurs, quickly turning into sleep.
The manic version of a modified simple alcohol intoxication is manifested by an elevated mood with carelessness and complacency, short outbursts of irritation, various "naughty" actions, annoying pestering, inappropriate jokes, loud laughter, and increased responsiveness to the environment. The picture of intoxication may resemble a manic state of organic genesis, less often - hebephrenic excitement.
With all the listed forms of altered simple alcoholic intoxication, there are always observed expressed in varying degrees symptoms of ordinary intoxication: deterioration in motor skills, articulation, behavioral changes depending on environmental conditions, intact orientation.
The most severe in terms of clinical manifestations and social consequences are such altered forms of simple alcohol intoxication as epileptoid and paranoid. Their very name emphasizes the well-known similarity with the main types of pathological intoxication.
Epileptoid variant of altered simple alcohol intoxication. The transformation of the clinical picture is determined by rapidly increasing motor excitation with the effects of irritation or anger towards others. The state deepens under the influence of opposition and is complicated by aggressive violent acts. Initially, aggression is usually selective and directed at persons directly related to the behavior of the intoxicated. As motor excitation intensifies, aggressive actions spread to everyone who is nearby. The disturbances of coordination of the movement observed earlier usually decrease or absolutely disappear. At the height of arousal, movement disorders and statements may become stereotyped, but a semantic connection with the situation of the initial period of intoxication is always preserved. Moreover, the intensity of speech-motor excitation and the aggressive actions associated with it is subject to certain fluctuations, depending on the verbal reactions of others. At the height of the episode, there is no complete separation of the intoxicated from the real situation. Mental disorders disappear critically, followed by drowsiness or sleep. Quite often there is amnesia of the period of pronounced excitement.
3. Pathological intoxication
Pathological intoxication is a hyperacute transient psychosis caused by alcohol intake. After taking a relatively small amount of alcohol, twilight confusion suddenly develops. There is a detachment from the environment, accompanied by disorientation of all kinds, but the usual automated actions remain, in particular the ability to move on foot or in transport. As a rule, the episode is completely amnesic. In the field of view of psychiatrists, those cases of pathological intoxication usually fall in which twilight clouding of consciousness is accompanied by productive disorders - figurative delirium, motor excitation, affective disorders (fear, rage, frenzy), visual hallucinations of a frightening nature, i.e. there is a "psychotic" form of twilight clouding of consciousness. In this state, socially dangerous acts are often committed. The actions of patients are entirely determined by the psychotic disorders that have arisen, the real situation does not matter for their actions. In the behavior of persons in a state of pathological intoxication, two main tendencies are usually revealed: defense with the desire to destroy the source of danger and flight from a life-threatening situation. Often these two tendencies coexist. With a certain degree of conventionality, two main forms of pathological intoxication are distinguished - epileptoid and paranoid, or hallucinatory-paranoid (more common).
In the epileptoid form of pathological intoxication, intense motor excitation predominates, usually in the form of meaningless and chaotic, aggressive actions of a stereotypical nature. The affect of frenzied anger and rage predominates, speech production is very poor, sometimes motor excitation is mute. Hallucinatory-delusional disorders are usually rudimentary.
In the paranoid (hallucinatory-paranoid) form of pathological intoxication, figurative delusions predominate, the content of which is usually situations life threatening intoxicated. The environment is perceived in an altered (illusory-delusional) plan. In a state of motor excitation, the ability to perform sequential and complex actions that outwardly look purposeful is often retained. Both motor and speech reactions are caused by psychopathological disorders, primarily delirium and altered affect. Much less often, frightening visual hallucinations predominate in the clinical picture; as a rule, these are isolated rather than scene-like phenomena. Oppressive, haunting, relatively simple visual hallucinations predominate.
alcohol intoxication pathological simple
Approximately in 2/3 of cases, pathological intoxication is replaced by deep sleep, and in the rest - by a sharp psychophysical exhaustion. A very common symptom of pathological intoxication is amnesia of a psychotic episode (almost 90%), with more than half having complete, and the rest partial.
There is evidence that in 10% of cases there are repeated states of pathological intoxication.
Pathological intoxication can occur in practically healthy individuals, but much more often a psychotic episode develops against the background of permanent and temporary additional hazards. The former include residual effects of transferred organic (TBI, neuroinfections) diseases. Of the temporary additional hazards, overwork, lack of sleep, increased or decreased ambient temperature, sudden temperature changes, intercurrent somatic and infectious diseases, as well as previous psychogenies are more common.
Forensic psychiatric examination qualifies pathological intoxication as a state of insanity, in connection with which persons who have committed socially dangerous acts in this state are exempted from criminal liability.
4. Treatment of acute alcohol intoxication
With mild and moderate degrees, general and local warming is recommended, inside 10-15 drops of ammonia in 100 ml of water.
In moderate and severe cases: gastric lavage, subcutaneous injection of 0.25-0.5 ml of apomorphine hydrochloride solution (to induce vomiting), bladder catheterization in case of urinary retention. In a coma - the introduction of cardiac drugs, intravenously, 100 mg of pyridoxine (vitamin B6), up to 1 liter of saline with 15-20 ml of 40% glucose. With strong motor excitement, vitamin B12 is recommended at a dose of 50-100 mg. The introduction of barbiturates is contraindicated!
In cases of severe coma - venipuncture with the withdrawal of up to 200 ml of blood, subcutaneous saline - 800-1000 ml. With asphyxia - inhalation of oxygen, artificial respiration, cytiton (1 ml of a 0.15% solution in / in), lobelin (1 ml of a 1% solution of s / c), inhalation of a mixture of 90% oxygen and 10% carbon dioxide.
A medical examination to determine the state of intoxication is a complex event that fulfills the social order of society, including the fulfillment of legal, medical, metrological, moral and ethical requirements.
Since the survey is carried out in accordance with the requirements of applicable laws and other normative documents, its consequences can lead to serious consequences for the examinee.
A feature of the medical examination is that not only specialists involved in this particular activity are involved in the examination, but also non-specialists in the field of medical examination - a wide range of doctors of other specialties and paramedics for whom the medical examination is an additional burden. As a rule, they are not sufficiently familiar with the legal basis of the examination, the procedure for its conduct and the criteria for substantiating the conclusion.
The basis of the medical opinion regarding the conditions associated with the consumption of alcohol is the data of a comprehensive medical examination. After its completion, the exhaled air is taken to examine it for the presence of alcohol. Blood for alcohol testing is taken in exceptional cases: for medical reasons (for example, severe injuries, poisoning, etc.), as well as in cases where, due to the severity of the condition of the person being examined, signs of intoxication cannot be detected.
The conclusion about intoxication is made on the basis of detection clinical signs intoxication and positive results examination of exhaled air for the presence of alcohol. The degree of intoxication is not indicated, since there is no such requirement in legislative acts.
Conclusion
Alcohol intoxication is an acute intoxication caused by the psychotropic effect of drinks containing ethyl alcohol (alcohol), causing inhibition of the central nervous system. In mild cases, it proceeds with ideomotor agitation and vegetative symptoms, in severe cases, with a further deepening of inhibition, the development of neurological disorders and a sharp depression. mental functions- up to a coma.
The severity of alcohol intoxication and its clinical features depend not only on the amount of alcohol taken, the rate of intake, air temperature and even its concentration in the blood. It also depends on the individual biological, mental characteristics of the individual - the type of nervous system, personality traits, as well as on his functional state in this moment. For example, the sensitivity to alcohol is sharply increased in psychopathic individuals, in persons with the consequences of craniocerebral injuries, who have had infectious and somatic diseases or central nervous system depletion in the past, and even just overwork immediately before drinking alcohol.
Clinical manifestations of alcohol intoxication are divided into the following main types:
A) simple alcohol intoxication;
B) modified forms of simple alcohol intoxication;
C) pathological intoxication.
Bibliographic list
1. Balabanova L.M. Forensic pathopsychology (issues of determining the norm and deviations). - D.: Stalker, 1998.
2. Dunaevsky V.V., Styazhkin V.D. Drug addiction and substance abuse. - L .: Medicine, 1990.
3. Kirpichenko A.A. Psychiatry: Proc. for honey. in-tov, - Mn .: Vysh. school, 1996.
4. Popov Yu.V., Vid V.D. Modern clinical psychiatry. - M.: "Expert Bureau - M", 1997.
5. Forensic psychiatry. / Ed. G.V. Morozov. - M.: Yur. Lit., 1978.
6. Forensic psychiatry: Textbook for universities / Ed. B.V. Shostokovich. - M.: Zertsalo, 1997.
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These are states of mild or moderate acute alcohol intoxication, in which (compared to simple intoxication) an excessively sharp increase or, conversely, weakening of some disorders occurs, or the sequence of their occurrence is disturbed, or symptoms develop that are not characteristic of simple alcohol intoxication.
Mental disorders undergo the greatest modification; much less - neurological. Altered forms of simple alcohol intoxication usually occur under various concomitant conditions: on pathological grounds (psychopathy, oligophrenia, mental illnesses of various genesis, with residual organic brain damage, early onset of alcoholism, formed alcoholism, simultaneous use of alcohol and drugs, combined intake of various types of alcoholic beverages, in cases where intoxication is preceded by a somatic disease or it occurs against its background, as well as in case of lack of sleep, overwork or psychogenic disorders.The selected options reflect the prevailing psychopathological disorders.
Explosive variant of altered simple alcohol intoxication. The state of euphoria is expressed weakly and easily spontaneously or under the influence of external insignificant circumstances by transient outbursts of sharp discontent, irritation or anger. Accordingly, the content of statements and behavior change. Usually these outbreaks are short-lived, alternating with relative calm and even complacency, but during intoxication they are repeated repeatedly.
Dysphoric variant of altered simple alcohol intoxication. A persistent state of tension prevails, accompanied by discontent, gloom, hostility or anger. In almost all cases, a low-dreary affect can be detected. Hostility and anger spread to everything seen and heard: the intoxicated becomes picky, caustic, cocky, looking for a reason to quarrel. A feeling of somatic discomfort and hyperesthesia are often detected. The above violations can be observed for several days after the alcoholic excess.
A hysterical version of a modified simple alcohol intoxication. The behavior of the intoxicated is always designed for the viewer. Often in statements that differ in pathos, various accusations against others, self-praise or, on the contrary, exaggerated self-reproach, predominate, fantasizing is often observed.
Depressive variant of altered simple alcohol intoxication. The clinical picture is dominated by a depressed mood of varying severity and shades. As a rule, the euphoria of the initial period is either absent or short-lived. In relatively mild cases, there is a subdepressive affect with tearfulness, unpleasant memories, self-pity. In more severe cases, there is longing, a feeling of hopelessness, anxiety, which are accompanied by self-reproaches and suicidal thoughts. Due to the lack of motor inhibition in this state, the likelihood of suicidal attempts is high.
Altered simple drunkenness with impulsive actions, as a rule, is observed in patients with schizophrenia and is usually accompanied by sexual perversions - homosexual acts, exhibitionism, flagellation. Pyromania and kleptomania are much less common.
Altered simple alcoholic intoxication with a predominance of somnolence. After a short and mild period of euphoria, a state of drowsiness occurs, quickly turning into sleep.
Manic variant of altered simple alcohol intoxication manifested by high mood with carelessness and complacency, short outbursts of irritation, various "naughty" actions, annoying pestering, inappropriate jokes, loud laughter, increased responsiveness to the environment. The picture of intoxication may resemble a manic state of organic genesis, less often - hebephrenic excitement.
With all the listed forms of altered simple alcoholic intoxication, symptoms of ordinary intoxication, expressed to varying degrees, are always observed: deterioration in motor skills, articulation, changes in behavior depending on environmental conditions, and intact orientation.
The most severe in terms of clinical manifestations and social consequences are such altered forms of simple alcohol intoxication as epileptoid and paranoid. Their very name emphasizes the well-known similarity with the main types of pathological intoxication.
Studies have shown that with these forms of intoxication in premorbid, almost half had alcoholism, and every seventh had psychopathy. On neurological examination, half had diffuse neurological symptoms. In 80% of cases, intoxication is preceded by psychogenic disorders, malnutrition, lack of sleep. On the initial stage intoxication, there are violations characteristic of simple alcohol intoxication. Subsequently, most often under the influence of an external, usually insignificant, but negative factor, the picture of intoxication changes. Typically, such a transformation is observed 1.5 hours after the last alcohol intake. The dose of alcohol is usually 300-700 ml (in terms of vodka). The resulting mental disorders have quite specific features, which makes it possible to distinguish two forms.
Epileptoid variant of altered simple alcohol intoxication. The transformation of the clinical picture is determined by rapidly increasing motor excitation with the effects of irritation or anger towards others. The state deepens under the influence of opposition and is complicated by aggressive violent acts. Initially, aggression is usually selective and directed at persons directly related to the behavior of the intoxicated. As motor excitation intensifies, aggressive actions spread to everyone who is nearby. The disturbances of coordination of the movement observed earlier usually decrease or absolutely disappear. At the height of arousal, movement disorders and statements may become stereotyped, but a semantic connection with the situation of the initial period of intoxication is always preserved. Moreover, the intensity of speech-motor excitation and the aggressive actions associated with it is subject to certain fluctuations, depending on the verbal reactions of others. At the height of the episode, there is no complete separation of the intoxicated from the real situation. Mental disorders disappear critically, followed by drowsiness or sleep. Quite often there is amnesia of the period of pronounced excitement.
A paranoid variant of altered simple alcohol intoxication. The transformation of the clinical picture is also determined by an increase in motor and speech excitation. Against this background, intoxicated people shout out separate words or short phrases, the content of which expresses a situation of tension or danger: “bandits”, “shoot”, “kill”, “run”, “hide”, etc. At the same time, statements appear that reflect the real situation, professional activity, unpleasant events preceding intoxication. Aggressive actions are usually differentiated, performed taking into account the situation, changing depending on the words and actions of others. Characterized by a decrease and even the disappearance of impaired coordination of movements and dysarthria. The statements of the intoxicated are usually somehow connected with specific events taking place around, they do not reflect the internal state and therefore it is more correct to designate them as delusional. Mental symptoms of intoxication usually disappear lytically, in 2/3 of cases there is amnesia of intoxication.
Simple alcohol intoxication (including all its modified forms) in various manifestations, especially considered in dynamics, retains to one degree or another the main signs of acute alcohol intoxication. In these cases, there is no twilight stupefaction of consciousness. This is evidenced by the safety of the intoxicated contact with the environment. A variety of actions, including inadequate, insufficiently motivated, are usually due to some external and specific reason throughout the duration of intoxication. The actions of the intoxicated, as well as their verbal reactions, are selective, they retain the ability to capture the situation and the changes taking place in it. The appearance or presence of persons capable of counteracting an intoxicated person with unpleasant consequences for him, one way or another affects his actions: he tries to hide, leave, or, conversely, gets even more excited, resists, and sometimes resorts to aggression.
There are two variants of the formation of a psychopathic form of alcohol intoxication. In the first case, in a state of intoxication, there is a sharpening of the personality characteristics inherent in the subject, the appearance of responses that are usually restrained outside of intoxication, the development of which in a state of acute intoxication becomes possible as a result of a weakening of volitional control and the influence of intensifying emotions that occur during intoxication. This is manifested in paranoid, hysterical, with delusional fantasizing and elements of eidetism (which is typical for persons with a hysterical radical and features of mental infantilism) variants of intoxication. According to the same mechanism, variants of acute alcohol intoxication with disorder of desires and with sexual disinhibition develop, which are not realized in the usual state and appear only in conditions of “washing away” the moral and ethical barrier due to alcohol intoxication.
In the second variant, emotional and volitional disorders that develop within the framework of chronic alcoholism and (or) organic mental disorder take part in the formation of a psychopathic form of intoxication. If at stage I of alcoholism psychopathic disorders are observed only in a state of alcoholic intoxication, then later they become an integral part of the "mental appearance" as a whole. The first pathogenetic variant of the formation of psychopathic forms of intoxication eventually passes into the second, which practically no longer depends on the initial characterological traits and is expressed in the development of explosive and dysphoric pictures of alcohol intoxication. At the same time, the explosive variant of alcohol intoxication over time, due to the increase in affective rigidity, can be transformed into a dysphoric one.
Affective disorders in alcoholic intoxication are usually observed in persons with a hyposthenic personality structure who have a hereditary burden for mental illness; that is, constitutional features in this case have priority over exogenous influences.
Along with this, affective forms of alcohol intoxication can develop in people with an organic mental disorder of a traumatic origin. According to the literature, a traumatic disease can occur with a predominant predominance of affective pathology, and there is a certain sequence in the development of symptoms. First, cerebrasthenic disorders are formed, as they deepen, astheno-depressive syndrome is formed. With a progressive course of an organic mental disorder, post-traumatic fear reactions appear in the clinical picture (Fairbank J.A., De Good, Jenkins C.W., 1981). At first, they appear only against the background of acute alcohol intoxication, which is, as it were, a "catalyst" and "indicator", revealing hidden, previously compensated ways of reacting to subjectively difficult situations.
Hallucinatory and delirious variants of alcohol intoxication usually develop in persons with alcohol dependence.
The dysphoric variant, as one of the varieties of psychopathic forms of alcohol intoxication, is characterized by gloomy spitefulness, aggressiveness, and dissatisfaction with others. With an increase in the affective component, the development of twilight clouding of consciousness is possible. This form of alcohol intoxication is characterized by general pattern progression of symptoms from milder to progressively worse.
This is consistent with the observations described in the literature relating directly to the state of acute intoxication. Acute poisoning, regardless of etiology, begins with a psychovegetative syndrome, followed by hallucinatory, epileptic, hyperkinetic. In addition, in patients with alcoholism, before the formation of a hyperkinetic syndrome, delirious or hallucinatory-delusional may develop. As the stupor deepens, the hallucinatory-delusional symptoms are leveled out due to cerebral edema and hypoxia, and hyperkinetic manifestations (myoclonus, hyperkinesis, tonic convulsions) begin to come to the fore. Hyperkinetic disorders that develop after delirious stupefaction indicate an unfavorable prognosis. The exit from the state of intoxication is carried out in reverse syndromic dynamics. In some patients, at the stage of exit from a coma, pathological sleepy states occur, accompanied by complete disorientation (Churkin E.A., 1985, 1989; Bolotova E.V., 1990).
F.F. Detengof (1963) defined the following syndromogenesis of psychotic states within the framework of acute alcohol intoxication: first, delirious stupefaction develops, which is regarded by many as the most prognostically favorable form of a disorder of consciousness, then, as the level of damage to mental activity deepens, hallucinosis, paranoid and schizophrenia-like psychoses develop sequentially.
The difference between atypical psychotic forms of intoxication in persons with alcohol dependence and alcoholic psychoses lies in the fact that the latter are not caused by the direct effect of alcohol on the brain, as in atypical alcohol intoxication, but by metabolic and neurovegetative processes as manifestations of metabolic disorders as a result of chronic alcohol intoxication.
However, in practice, it is difficult to differentiate these states. As noted above, in the anamnesis of patients with alcoholic psychosis, psychotic forms of alcohol intoxication may be observed. With the progressive development of alcoholic disease, quantitative rather than qualitative changes in the clinical picture of acute intoxication occur. At the same time, the longer the binge preceding psychotic disorders, the more reason to regard them as alcoholic psychosis.
In persons with an organic mental disorder, the clinical picture of alcoholic psychoses often differs from the classical description. Therefore, it is more successful in this case to qualify it as "exogenous psychosis".
With the development of exogenous psychosis (including alcoholic), in contrast to atypical psychotic intoxication, a prodromal period is observed in the form of a feeling of general physical ill-being, increased fatigue, irritability, sleep disturbance, reduced mood background and the final stage in the form of asthenic syndrome, against which residual delusions, delusions of perception in the evening, incomplete criticism of psychotic experiences. The psychotic variant of intoxication is limited to the period of intoxication, the beginning and end of psychotic symptoms are quite clear.
The development of movement disorders during intoxication is based on deep brain damage (permanent soil) when exposed to a subjectively increased dose of alcohol (temporary soil factor). Comparison of the role of permanent and temporary soil factors with individual forms of acute alcohol intoxication with an atypical clinical picture showed that the less pronounced the signs of an organic mental disorder, the greater value have additional exogenous hazards that immediately precede atypical intoxication, and the main factor in the temporary soil is psychogeny. With a pronounced depth of organic disorders, an increasing influence of internal biological mechanisms with a decrease in the share of exposure to temporary factors, primarily psychogenic. This pattern was previously described in psychopathic personalities (Kusakin V.A., 1992).
Thus, in accordance with the teachings of J.H. Jackson (1864) about the "layered" construction of mental activity and by analogy with the ideas of A.V. Snezhnevsky (1983) about "enlarged monoqualitative syndromes" and about the depth of damage to the mental sphere, all identified forms of alcohol intoxication can be arranged in a certain sequence from the least pathological to the most pathological as follows: psychopathic, affective, psychotic and forms of intoxication with movement disorders. Personality disorders are the axis on which the identified A.V. Snezhnevsky "monoqualitative syndromes". Personal characteristics themselves are also dynamically modified under the influence of endogenous and exogenous factors. Psychopathic forms of atypical alcohol intoxication, therefore, reflect the involvement in the pathological process of only the characterological "core", which is the easiest option. This principle corresponds to the position of O.N. Arnold and N. Hoff (1961) that the impact of various psychotropic drugs on the psyche of healthy individuals has its own characteristics - low doses cause personal psychoreactive manifestations, and large doses - exogenous types of reactions. These ratios are shown in the figure.
Rice. Clinical-dynamic relationships
various forms of atypical alcohol intoxication
Based on the foregoing, the division of the entire population of the examined into groups, taking into account the forms of atypical alcohol intoxication that are detected in them, can be made according to the following principle. Persons who had movement disorders in the structure of acute alcohol intoxication were divided into one group, regardless of whether they had other atypical forms of intoxication. The second group included subjects who experienced psychotic phenomena while intoxicated. The third group consisted of persons with affective disorders. The fourth group included those surveyed who had only psychopathic disorders. Thus, in persons with a deeper level of mental damage, which is reflected in the form of atypical alcohol intoxication, there are disorders related both to this level and to more "superficial" ones.
